Entry Confirmation - Please review the following information

Horse Information
Name:	Disco	Height:		Birth Country:
Breed:	Hannovarian	Sire:		Year of Birth:
Sex:	Gelding	Dam:		Breeder:
Color:		Dams Sire:		Passport #:

Information	Horse	Rider	Owner	Trainer	Coach
Name:		MELODY EVANS	MELODY EVANS	MELODY EVANS
Address:		199 Podunk Rd	199 Podunk Rd	199 Podunk Rd
City/St/Zip:		CANDIA, NH 03034-2017	CANDIA, NH 03034-2017	CANDIA, NH 03034-2017
Country:		usa	usa	usa
Telephone:		603-657-4269	603-657-4269	603-657-4269
E-mail:		laplante10@hotmail.com	laplante10@hotmail.com	laplante10@hotmail.com
Citizenship:		usa	usa
Rider Status:		Adult Amateur
		5469014	5469014	5469014
		235359	235359	235359
Need Safe Sport:		No	No	No
Need Signature:		No	No	No	No
Need Coggins:	No
Need Vaccines:	No
Need Parent Signature:				No
StallGroup:

Need List

Class	Day	Class Name	Test Name	Qual/Div	Need FS Doc	Amount
19	Sunday	USEF Second Level, Test 1	USEF Second Level, Test 1 2023	No	No	$ 30.00

Stable Fees	Rate	Quantity	Amount

Other Fees	Rate	Quantity	Amount
Non-Member Fee (per class)	$ 15.00	1	$ 15.00
Processing Fee	$ 20.00	1	$ 20.00

Payments	Amount
Check	$ 65.00

Class Total	Stable Fees	Other Fees	Total Fees	Payments	Amount Due
$ 30.00	$ 0.00	$ 35.00	$ 65.00	$ 65.00	$ 0.00

Memo
Complete entries must include NHDEA waiver and 12-month coggins!

User	Date / Time	Notes
Secretary	5/31/2023 5:59:50 AM	UPLOADED:
Entrant	5/31/2023 9:45:06 AM	ACCEPTED:

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